"Safety First": diseño de un checklist anestésico en pediatría / "Safety First": Design of an anesthetic checklist in pediatrics

Introducción: La mejora de la calidad en el cuidado de la salud conlleva el diseño de procesos fiables, que prevengan y mitiguen los errores médicos. Los listados de verificación (checklists) son herramientas cognitivas que reducen dichos errores. El objetivo de este trabajo fue diseñar un checklist anestésico en Pediatría para su posterior implementación en nuestro hospital. Metodología: Se aplicó el método Delphi con 3 rondas de cuestionarios: uno genérico para aportar dimensiones e ítems y 2 específicos para puntuar individualmente los ítems y globalmente el checklist (mediana), y para medir el nivel de consenso intraítem (rango intercuartil relativo) y la fiabilidad (prueba de rangos con signo de Wilcoxon). Resultados: La versión final del checklist obtuvo una elevada puntuación global (Med 9) con un nivel de consenso muy alto (RIR 5%). Se alcanzó el consenso interno en todos los ítems (RIR ≤ 30%). El test de Wilcoxon no encontró diferencias estadísticamente significativas y evidenció la fiabilidad o estabilidad de la respuesta entre rondas consecutivas. Conclusión: El Checklist anestésico en Pediatría ha sido diseñado metódicamente para su implementación y uso en nuestro hospital

Introduction: Quality improvement in health care entails the design of reliable processes which prevent and mitigate medical errors. Checklists are cognitive tools which reduce such errors. The primary objective of this study was to design an anesthetic checklist in Pediatrics to be implemented in our hospital. Methods: Delphi technique was used, with 3 rounds of questionnaire surveys: a generic questionnaire to obtain dimensions and items; and 2 specific ones to score individual items and obtain an overall rating for the checklist (median), and to measure the level of consensus (relative interquartile range) and internal reliability (Wilcoxon signed-rank test). Results: Final version of the checklist obtained a high overall score (Med 9) with a very high consensus (RIR 5%). Internal consensus was reached on all items (RIR ≤ 30%). Wilcoxon signed-rank test found no statistically significant differences, demonstrating reliability or consistency of responses between consecutive rounds. Conclusion: The Anesthetic checklist in Pediatrics has been methodically designed for implementation and use in our hospital

Estudio piloto sobre el uso de la Hiperfiltración Venosa Continua para el manejo de pacientes en estado crítico con inflamación desregulada / A pilot study into the use of Continuous Venous Hyperfiltration to manage patients in a critical state with dysregulated inflammation

Introducción: Los paradigmas de la hemofiltración para manejar pacientes críticos con una respuesta inflamatoria desregulada (RID) evalúan la función renal para su inicio, adaptación y finalización. Presentamos la Hiperfiltración Venosa Continua (Protocolo CONVEHY), en el cual una membrana de adsorción inespecífica (AN69-ST-heparina anclada) se utiliza con citrato como líquido anticoagulante y de sustitución. El protocolo CONVEHY utiliza herramientas fácilmente disponibles para lograr objetivos renales y no renales, guiándose por las respuestas fisiopatológicas. Objetivos: Comparar la respuesta a la membrana AN69-ST-HA cuando se utilizó heparina (He, n = 5: protocolo estándar) o citrato (Ci, n = 6: protocolo CONVEHY) para evaluar si fuera factible un estudio mayor sobre los beneficios de este protocolo. Materiales y métodos: En un estudio retrospectivo, se evaluaron los beneficios del protocolo CONVEHY en pacientes con RID en una unidad de cuidados críticos quirúrgicos (UCCq), evaluando las puntuaciones SOFA (He 11 +/- 2,35; Ci 11 +/- 3,63; p = 0,54) y APACHE II (He 28,60 +/- 9,40; Ci 24 +/- 8,46; p = 0,93). Resultados: Hospitalización (He 35,2 +/- 16,3 noches; Ci 9 +/- 2,53; p = 0,004), hospitalización tras el alta de UCCq (He 40,25 +/- 21,82; Ci 13,2 +/- 4,09; p = 0,063), pacientes hospitalizados > 20 días (He 80%; Ci 0%; p = 0,048), días con ventilación mecánica (He 16 +/- 5,66; Ci 4 +/- 1,72; p = 0,004) y la mortalidad predicha (55,39 +/- 26,13%) frente a la real en ambos grupos (9,1%; p = 0,004). Conclusiones: El protocolo CONVEHY mejora las respuestas clínicas de los pacientes con una RID, destacando el valor potencial de realizar estudios más grandes y confirmatorios

Introduction: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. Objectives: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. Materials and methods: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 +/- 2.35; Ci 11 +/- 3.63: p=0.54) and APACHE II (He 28.60 +/- 9.40; Ci 24 +/- 8.46: p=0.93) scores. Results: Nights in hospital (He 35.2 +/- 16.3 nights; Ci 9 +/- 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 +/- 21.82; Ci 13.2 +/- 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 +/- 5.66; Ci 4 +/- 1.72: p=0.004), and the predicted (55.39 +/- 26.13%) versus real mortality in both groups (9.1%: p=0.004). Conclusions: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies

Rotura parcial de Port-a-Cath(R) en síndrome de «pinch-off» de bajo grado / Port-a-Cath(TM) partial rupture in a low-grade pinch-off syndrome

No disponible

Anestesia baja en neurotoxicidad / Low-neurotoxicity anesthesia

No disponible

Fibrilación auricular en paciente de 22 meses durante palatoplastia / Atrial fibrillation in a 22-month-old patient during cleft palate surgery

No disponible

Bloqueos centrales en pediatría: una revisión de la literatura actual / Central blockades in pediatrics: a review of current literature

La anestesia neuroaxial pediátrica es una herramienta efectiva que puede ser usada como complemento o alternativa a la anestesia general. Sin embargo, siempre ha generado dudas en cuanto a su utilidad y relación riesgo-beneficio. El propósito de esta revisión es describir el papel actual de los bloqueos centrales en la población pediátrica, actualizar aspectos prácticos y de seguridad, así como repasar los últimos avances tecnológicos aplicados a este procedimiento (AU)

Pediatric neuraxial anesthesia is an effective tool that can be used as a supplement or alternative to general anesthesia. However, there have always been doubts about its usefulness and risk-benefit ratio. The purpose of this review is to describe the current role of central blockades in pediatric patients, upgrade practical and safety aspects, and review the latest technological advances applied to this procedure (AU)

Conocimientos sobre ética asistencial de los residentes de pediatría / Knowledge of health care ethics in paediatric residents

INTRODUCCIÓN: La enseñanza de la bioética se ha incorporado a los planes de estudio de medicina y al programa para médicos residentes. Sin embargo, la transmisión de conocimientos basados en la práctica clínica habitualmente no se realiza de una manera bien estructurada. OBJETIVO: Valorar los conocimientos de ética de los residentes de pediatría españoles y analizar su relación con la formación recibida durante la licenciatura y el periodo de residencia. MATERIAL Y MÉTODOS: Se diseñó una encuesta con 20 preguntas tipo test destinada a evaluar conocimientos éticos básicos con repercusión sobre la clínica. Se valoraron la formación recibida durante el pregrado y la residencia, y los principales conflictos éticos afrontados. RESULTADOS: Se obtuvieron 210 encuestas remitidas desde 20 hospitales: 47 correspondientes a (R1), 49 a (R2), 57 a (R3) y 57 a (R4). La media de respuestas correctas fue de 16,8. No hubo diferencias entre los residentes de distinto año ni entre los que manifestaron haber recibido o no formación específica. Se contabilizaron más fallos en preguntas relacionadas con el consentimiento informado, ley de autonomía del paciente, los principios implicados en la calidad de vida, la sistemática del análisis de casos y la dimensión de la justicia distributiva. CONCLUSIONES: La limitación del esfuerzo terapéutico se ha identificado como el principal problema ético en la práctica clínica. Gran parte de los conocimientos sobre ética se adquieren en el pregrado y varían poco durante la residencia, lo que hace necesarios mayores esfuerzos organizativos y docentes durante este periodo

INTRODUCTION: Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical practice is not well structured. OBJECTIVE: To evaluate the knowledge of bioethics in Spanish paediatric residents, and to analyse how this relates to the medical education during graduate and post-graduate training. MATERIAL AND METHODS: A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical practice. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. RESULTS: A total of 210 completed questionnaires were received from medical residents in paediatrics from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. CONCLUSIONS: Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical practice by Spanish residents in paediatrics. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in paediatrics

Impact of computerised chemotherapy prescriptions on the prevention of medication errors

OBJECTIVES: The authors sought to evaluate the impact of computerised chemotherapy prescription on the reduction of medication errors. The purpose of this study was to assess the incidence of errors present in electronic versus manual prescription. MATERIAL AND METHODS: The data gathered from computerised chemotherapy prescription sheets were submitted to a prospective analysis as cases of the intervention groups. The control group was comprised of the handwritten chemotherapy prescription sheets. Chemotherapy prescriptions for consecutive oncology patients were analysed by 2 independent examiners, who investigated errors of omission, commission, interpretation of dates, abbreviations and illegible handwriting. The proportion of treatment prescriptions containing one or more errors and the median of errors were calculated in order in both groups. RESULTS: At least one error was detected in 100% of the manual prescriptions and in 13% of computerised prescriptions (p < 0.001). The median of errors per computerised prescription was 0 (range: 0- 1), whereas in manual prescriptions the median was 5 (range: 1-12) (p < 0.001). Errors of omission were predominant in manual prescriptions. Errors of commission were limited to 1 case of unjustified cytostatic agent infra-dosage in a computerised prescription. This error was present in 3 cases in handwritten prescriptions and, in addition, 1 case of premedication drug substitution was detected. Errors of interpretation of the date, use of abbreviations and illegible handwriting were frequent among manual prescriptions and were absent from computerised prescriptions. CONCLUSIONS: Electronic chemotherapy prescription is a powerful tool. In this study it has been shown to decrease chemotherapy-related medication errors and ensure that safe chemotherapy practices were followed (AU)